HOLLY ELIZABETH VANNITAMBY DO Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****51

License Status

ACTIVE

Business

Title

First Name

HOLLY

Middle

ELIZABETH

Last Name

VANNITAMBY

Business Name

HOLLY ELIZABETH VANNITAMBY DO

Original Issue Date

10/17/2019

Effective Date

04/22/2023

Expiration Date

07/31/2026

City

PEORIA

State

Zip

61615

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/22/2023